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HomeMy WebLinkAboutPermit Electrical 2005-11-17 ',I'('\'''''''p projp CtLJ1.I,.,~.,~..,., ". u,.,'~..' t=...,...,.., ...............'.,...,t,....h..........,....e.....,........f..,.............,...O..... lIowin9 ass no~el~lfe I>r land use SPl'l . iClFI~L':: " . L.' ling '..' ., "..,~~.~~~...~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (54r>726~368~,_"f!~i!~l~ ELECTRICAL PERMIT APPLICATION .I '.:.: i'.' . City Job Number CoIl12005.. 0 Ih '1.../ Dat~"lfrI7ft/S , JOB DESCRIPTION J&cc/VLLef OY1~ ~ermits are non-traD~ferable and e'fpire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. Electrical Contractor ~ e~L Address \9\0 0 28n-\ S;:T ~ City~ ri06 Vtt;lb Phone '14-7-22J3 Supervisor License Number 2..<:t3 w S Expiration Date \ D -l .... 2or:J7 Constr. Contr. Number \ 2,,1'2, Expiration Date S- ".., Z ?. ~ 0'1 Signature of Supervising Electrician ~ iLL 1k ffil1tt-a - / cY ~- (\ Owners Name L,loLfd lfA.htl Address tQ/:1 ~~r~ ' City Sf r"YVtfi~It:fPhone ""~7'" U..J 8 J 'U;~ OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 3. A. Service Included 1000 sq, ft. or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Each Ma~b1ct'd Home or MN.Qitj~~:lIing Service or FtlmS PERMIT SHALL EXPIRi-If T~~O B. 20AN."MO 100Y PERIOD. 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only / $ 61,00 $ 75,00 $125.00 $163,00 $375.00 $50,00 ~. 00 c. Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100,00 Over 6em ~~~;n;nbOd\lolfdee' "B" above. D. "-..-":i. ,I.~. J i " ,'} I" New M\1(ef~t'Q'b~:r:{~~~~~~~~~ ~~f-~~l!-,n!)J' One <Dii;Qtlit Yeu n1ElY obtain CO~<,' ,$43.00' Each Ar.lditj'Otlali12ir,cuitor,with, :-'~~; ~","; ~', >::i ':i 'l!J~, ....\..j ,He '~C;' 'lo;l. (''. ~J'",. "'-'l, $ 3' Service..OI: Fe,~rleF Peoni't' . " ',~' ~,:' v,,:: ,; .00' ,C; m:.rmuc;l lOr lflO U"''1nn "'" 'I ' I ..., : \,..;~~.. U~lJI~',/ :\C':L E. Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50,00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. !;() .00 3.~o S-:OD Sl.SV 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application I-03.doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-01621 ISSUED: 11/17/2005 APPLIED: 11/17/2005 EXPIRES: 05/17/2006 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 612 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264311100 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Reconnect Only. Owner: Address: TUHY LOYD W & LINDA L 612 CENTENNIAL BLVD SPRINGFIELD OR 97477 Contractor Type Electrical Contractor ALERT ELECTRIC INC NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AU' HUKILtU UI~[)i:~ -;1110 rem.1lT I~ WE CONTRACTO ION I " ABANDONED FOR ANY 180 DAY D. License Expiration Date 12772 OS/22/2007 Phone 541-747-2213 BUILDING INFORMATION I ,,#ofUnits: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: ___ ,_ __ , i\ < .' \1' ,1\1, r-'\ "I-:','-J"I' ' SprinkJed Building:; "" I'. .-' 'n/a , ' .r-f""'I!1,,"",'d tJ 11,_~ ':~ -:_..... ~ ,...-, '\ Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: I ' , Occupant Load: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: , Solar Setbacks: I DEVELOPMEN1HNFORMA.tfIONi't ~i:.:~2 ,;~~',~r;' " r' In Vi'\I\ 0;J;.:-GU, -'"u i \., II II Cl,~I, ,) : REQUIRED PARKING Y 1 ',' ..., ...-, ,,' 1-_""",,\ ,:C 1_\/ O nqso. OL! ma~f OOl21,l CO:~k,c wl,I,~ c':~" J verlay DfSt. " ," .. (: I _'~. ",.0 "":::rota1.",, # St t T r.~R.I~GG Lila cemsr. ,", lAG. ',' '~~'H',")' ,Jd,., ~ d' ree rees- ~u. . . "" U""!" I ,aQ lcanpe . P d D. 'Rij"'tl,"'a( Wi' Ills ,-,reOOil' LI :,y ,,"0, C'!'I\",-",urt ave rive :J~ <=l ,ompact: C ' . .' 800 "32 )3 "i') % of Lot Coverage: snL8r IS 1- .0 _ - _ L,., . I PUBLIC IMPROVEMENTS I .' Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e 1 of2 ~ :-:-$PFI,',',,',N, "QF'I,tE, ,L.O~,.'."",.',,'.' '>['",.... ' WtL.,J,j - i ,..,,...." ._ ___"~_C_."_..'.~"._.._ ,~_. .. ... .. "..... " , Status Issued CITY OF SPRINGf11ELU . Building/Combination Permit PERMIT NO: COM2005-01621 ISSUED: 11/17/2005 APPLIED: 11/17/2005 EXPIRES: 05/17/2006 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project LFees Paid' Fee Description + 10% Administrative Fee + 7% State Surcharge Service Reconnect Amount Paid Date Paid Receipt Number $5.00 $3.50 $50.00 11/17/05 11/17/05 11/17/05 2200500000000001594 2200500000000001594 2200500000000001594 Total Amount Paid $58.50 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Reouired Insoections I Electric Service: Approval required prior to utility company energizing service. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Pa2e 2 of2 '225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2005-0 1621 COM2005-0 1621 COM2005-01621 Payments: Type of Payment CreditCard, ), ,'I ,~ .'; { I ;'~ A ~). 11/17/2005 RECEIPT #: Description Service Reconnect + 7% State Surcharge ' + 10% Administrative Fee Paid By ALERT ELECTRIC "'~ty of Springfield Official Receipt " ' , .:velopment Services Department Public Works Department 2200500000000001594 Date: 11/17/2005 Item Total: Check Number Authorization Received By Batch Number Number How Received ddk 017872 In Pe'rson Payment Total: Page 1 of 1 1:24:55PM Amount Due 50.00 3.50 5.00 $58.50 Amount Paid $58.50 $58.50 '\